Community Vaccination Status; An Anonymous Survey

1. Page 1 of 1

Dear Tower families,

This year, we hope to host on-campus events for our school community. We want to protect the health of our whole community by being in compliance with CDC and MDPH guidelines regarding indoor and outdoor events. It will be helpful, for planning purposes, to know the percentage of adults in our school community who are vaccinated.

One parent/guardian can complete this 1-minute, anonymous survey for the adults in their household, indicating your vaccination status or your preference to not disclose your status. Your privacy is important to us; you will not be asked to identify yourself.

Question Title

* 1. Please indicate the vaccination status of parent/guardian 1 in your household.

Vaccinated (two doses of Pfizer or Moderna, or one dose of J&J)

Partially-Vaccinated (one dose of Pfizer or Moderna)

Un-Vaccinated

I prefer to not disclose my vaccination status.

Comments (optional)

Question Title

* 2. Please indicate the vaccination status of parent/guardian 2 in your household.

Vaccinated (two doses of Pfizer or Moderna, or one dose of J&J)

Partially-Vaccinated (one dose of Pfizer or Moderna)

Un-Vaccinated

I prefer to not disclose my vaccination status.

Comments (optional)

Page1 / 1

100% of survey complete.